Letter to a biomechanically - minded therapist

A new member at SomaSimple wrote:

I am still trying to get a grasp on everything I have been reading on this site. I would like to hear the rationale from an Ectodermalist of why I had success this patient.

Patient: 39 y/o female presenting with c/o left lateral knee pain while jogging. No reproduction of symptoms with AROM, joint mobility, palpation, special tests. Onset of symptoms after approx 3 minutes of jogging on treadmill. Patient described symptoms as "deep in the joint" and "sharp". Other objective findings: weak L hip ERs, L midfoot pronation.
Video analysis of running mechanics: excessive L DF and close to full L knee extension at heel strike.
Treatment: decreased patient's stride length by increasing number of steps per minute with use of a metronome; exercise for L hip ERs
Results: patient ran 10 minutes pain free with decreased step length at same visit
Rationale: decreased stride length will decrease ankle DF and increase L knee flexion at heel strike in order to decrease ground reaction force at L knee joint

Name deleted

I wrote back.
Inevitably I missed saying a few things that are probably important for clarity, so this blog post will be an elaboration of that response.

First of all, congratulations on having interacted with, and helped abate, a problem a patient was having with movement and pain. The question you seem to silently be asking sounds like, "because I used biomechanics and biomechanical analysis to help solve the problem, why should I bother trying to learn how to see things ectodermally?" 

This always seems to be the first question people ask. The second one is, how is what you do different from myofascial release? Which used to drive me batty, but doesn't anymore, because it's been so long since I extracted my own brain from entanglement with all the flawed ideas inherent in myofascial release as a treatment concept, But now, back to the letter:

I think that is a fair question. I really do.

I wrote a bit about the focal length of treatment a little while ago. Here is a link; Operator/Interactor.
So, it boils down to biomechanics and biomechanical analysis being a good example of "patternicity", fraught with Type I and Type II error, or pareidolia (seeing the virgin Mary in a piece of toast) or apophenia ("experience of seeing meaningful patterns or connections in random or meaningless data").
Manual therapy is full of pattern seeking and finding, and so is any sort of therapy, really. Psychotherapy is full of this too. A practitioner sees a certain kind of pattern, or sees a pattern a certain way, and starts to explain how he or she sees it, then other people (suggestible as we all are) start to see what he or she means, it all makes sense, and voila, a new institute is born!

 So was medicine for a very long time, and still is to a great extent, burdened by patternicity-seeking.

One of the biggest irritations I still have, actually, is the enormous influence still wielded by the Biggest Mesodermalists of Them All, Orthopods and Physiatrists, over the thinking processes of therapists of the physical persuasion. Why do they persist in knowing nothing about neuroscience? Because they are making a fine living from injecting joints and needling imaginary things called trigger points that they decided arbitrarily are located in muscle somewhere/somehow, and teaching new generations of keeners to think the same way they do about pain problems.

Last summer I sat and fumed for an hour, listening to Jay Shah talk about trigger points and needling them. He admitted upon questioning by Neil Pearson (then chair of CPA's Pain Science Division) in the audience that day, that no one has ever actually found trigger points to exist, but he had gone on for an hour before that, showing zippy video-embeds of naked muscles (skin removed) and needles put into them this way and that, leaving every brain in the room with the overwhelming impression that he was showing us real, anatomical, mesodermal entities that were "pain" generators. Way to mess with peoples' minds, Jay Shah. Way to not help anyone understand pain or the nervous system better. Way to reinforce Cartesian ideas about "pain" (not just nociception) being carried on pain strings inside the body up to the brain. That model is really not that clinically useful anymore. For any of us who don't like needling, for sure. Way to keep allied health professionals separated from a longer conceptual focal length and perhaps wider angle conceptual view of pain and its common persistence. Way to keep us in the dark. Way to reinforce mesodermalism.

But now, back to the letter:

Now, about your patient: You used a very well-established patternicity model to help your patient. There is nothing wrong with helping patients any way you can. However, there is a great deal of information in the last 30 years or so about the brain, about how the body and brain interact, about pain, about how the brain both creates and responds to a pain experience.

This forum, if it is about anything, is about exploring how to connect all that to what we all, in one way or another, do for a living, which in my opinion is human primate social grooming. Human primate social grooming (HPSG), to me, boils down to a wordless kind of interactive, kinesthetic support, fully accessing every affective and afferent channel in that patient that is therapeutically available to us, to help them. Them. Them. 

Them.
This is uppermost on my mind this weekend, because of a recurring fight I always end up in with chiropractors. The latest battle was on Facebook last week. This could be a whole separate blogpost, but briefly, I posted a video of Alannah Myles and immediately had my throat jumped down by a chiropractor who accused her of lying. Yes, lying. About her own experience of being in a body, taking it to see someone she thought would be able to help her, but hurt her instead. I documented the exchange here. To my mind, any profession that doesn't put the patient and his or her well-being, front and center, but instead reinforces victimhood by placing itself first and foremost in the mind of the practitioners it trains, is the exact opposite of what a healthcare profession or professional should be. I consider that to be an unconscionable juxtaposition, completely indefensible, although chiros really really try, reflexively, to defend themselves before any other thought crosses their minds, and end up weeing all over themselves and their (so-called) profession in the process. And they never, ever seem to get how ludicrous they are/it is when they do that.

But I digress. Back to the letter:

What the problem is, with patternicity, is that conceptualizations can interfere with our own brains. Several problems can emerge if we aren't really careful to always keep the patient first and foremost. A few examples, randomly, in no particular order:

1. We can become way too reliant on the tool, instead of what it is we are supposed to be doing with it. There will always be a patient who comes along who doesn't fit your tool/concept. Then what?
2. We can end up being tool collectors which can lead to a lot of confusion.
3. It's really, really hard to study therapy from a patternicity standpoint, because of there being nothing objective to measure, just a pattern in a head that feels real but isn't, because it isn't an object, it's an objectification.

Treating a set of ideas we cart around in our heads in a basket might overlap a good deal of the time with actually managing to help patients, but it can't always, and if we rely on conceptual baskets of ideas only, we will lose the paddle far up the creek on a regular basis.

Back to the letter:

Instead, what some of us old fogies have come to realize, is that we might have saved ourselves a lot of $ and frustration if we hadn't combed carefully through all those patterns, gurus, and institutes out there that are patternicities based on mesodermally-derived tissue. What is mesodermally derived tissue? It's the 98% of the body that is not nervous system (i.e., bones, joints, muscles, fascia, tendons, ligaments, etc.) Instead, we wish we had stuck with key principles.

In this post, Ian Stevens nails the essence of the problem we all face whether we are currently practitioners of one kind or another, or are people in pain (and I can pretty much guarantee that we all will be one day like it or not); ian s, paraphrased:

Quote:

"..illness Pain is not (only and always) a mechanical process. Illness Pain is always multifactorial. That’s part of the nature of complex systems – they aren’t simple! The thrust of the argument is that it’s whole people who get ill pain, body and mind, inextricably interfunctioning, and not only that, but it’s whole people, embedded within the environments of their lives who get ill pain. I use the plural there deliberately. We are embedded in multiple environments, not just physical ones, but also social, cultural and narrative ones. We are meaning-seeking creatures."

I just loved Ian's depiction of nested problems, nested in contexts, several simultaneous human contexts, inextricable from them, rather like the way manual therapists find themselves inextricably bound inside the conceptual worlds they build and pay to have built around their/our own brains. Man oh man, we had better start building in some cognitive nimbleness to avoid being screwed in the left ear by hucksters from our own human primate social grooming troops, and/or in the right ear by 'submission to authority' in the form of actual medical doctors, like Shah (see above), who should be helping HPSGs find a way out of the mesodermal concept quicksand instead of deeper into it. 

Back to the letter:

To sum up, as long as we are putting the patient first, ahead of ourselves, ahead of our professional pride, ahead of being attached to results, ahead of being attached to our favorite patterns, or methods, or anything else, we'll probably do just fine in the long run and work our way out of the conceptual maze and realize that all we can ever know is just how to be just and ever and only one step ahead of our patient. Which is fine, because as their therapist you don't ever want to be any farther ahead than that, or they might lose track of you and you of them. It's only one step, but as long as it's the right step, you'll always go places, and be able to help them, and never hurt them. 

The Expert Mind.
The Patient's Brain: The neuroscience behind the doctor-patient relationship

All the best.

Diane

 

First day of "vacation"

I'm officially not at work now, as of yesterday at 4:45 PM. And I officially do not have to return until January 5th, in the afternoon. (L-o-n-g-.........-e-x-h-a-l-e.)

Part of me feels, oddly, very upset by the prospect of all this idleness. Clearly I seem to have, overall, lost touch with my inner irresponsible child parts.

It will be a first real break (longer than three weeks) from work in over 14 years. It will be the first time I will have been out from under the Dark Grey December Sky Lid of the temperate rain forest in 18 years. The part that feels upset is undergoing a taste of Freedom Vertigo, is all. It's a minor cognitive tilt-a-whirl that I'm sure will pass, once I get to Maui and experience immersion in high photon density. Maybe even before then.

I'm thinking I'll get some time to contemplate what I'd like to be when I grow up (a job that is never really over), how to safely disengage from the life I've constructed here and move on, hopefully to a more sunny location, and some kind of reasonable time frame to conduct this transition, make it gentle on everyone including me.

Does the economy worry me? A little.. so it's a good thing that I have never really worried a whole lot about stuff over which I have no control, like the value of money. When the opportunity to move smoothly presents itself, I will do so in a heartbeat, even if I lose money in the process.

If I were really concerned about money, I'd never spend any, and I'd not have become a PT in the first place, because you never get rich doing human primate social grooming. At best, you make a comfortable living doing honest work that's meaningful in the moment, involves helping others, and does no harm. I can do that anywhere. It's one of the things that attracted me to PT in the first place. Who needs more than that out of life? Really?

Speaking of doing no harm, I received yet another missive from my good friend and correspondent, "anonymous," who regaled me yet again on the blogpost I wrote concerning Sandy Nette and her lawsuit. See Alberta woman with chiropractic stroke sues bigtime. Sorry anonymous, I am not going to publish your comment. Surely you can read, and have already read this part:

"Since I put this blogpost up I've received a couple comments from one or two readers, both named "anonymous." I did not allow their comments to appear. They are glaringly pro-neck-manipulation, and I think the pro-neck-manipulators have already had far too much leeway in the realm of swaying public opinion to give them any sort of platform, however buried, obscure and humble this blog may be.

It's because of:
1. chiro training in a rationalized (as opposed to rational), deliberately propagated, bizarre belief system, combined with
2. a cultivated and honed persuasive attitude,
3. which appears aimed at propagating reckless enactment of a type of human physical social grooming (high-neck-manipulation) which is irrelevant and unnecessary in the first place,
4. against all common sense AND scientific investigation,
5. for the sole purpose of making $,

... that this woman became tetraplegic.

I have too much respect for the human nervous system to ever condone manipulation of its high-neck housing; therefore, "anonymous," I consider my prevention of your promotion of it on my blog, a positive choice - an action (however tiny) against letting myself and this blog be a vector for further perpetuation of your particular memeplex. And I happen to think it's an accumulation of tiny actions that count in life."

I suspect that my dear friend anonymous constructed his straw man argument in Word and is simply surfing his way around with the help of google, and like a crazed harpy (even though probably male), is dropping his load everywhere he can. I'm sure I've already read the exact same prose many other times, in many places.. anyway, no need for me to allow it here. I get to set editorial policy in my own blog, anon. Tough darts, but that's how it's gonna be. Try popping this delightful bubblewrap instead.

See? I just guided someone from a harmful activity over into an enjoyable and harmless one. That's part of what I help people figure out how to do in my work.

Another part is helping people figure out how to do what they want to do without having to endure pain while doing it. The last but not least part is teaching people about pain, and engaging with their physical nervous system to relieve it while they and their nervous system simultaneously learn how not to have it. Do I treat necks? Yes, of course I do. Do they improve? Yes of course they do. Do I pop them? Never. See?

Really, I do love my work. But also, really, I do need this trip to a Land of Photons, and I need it now. I want a big blue-dome sky over me and gorgeous glinting light ricocheting around, vigorously bouncing off surfaces of everything instead of feebly allowing itself to be sucked straight into them. I want vibrant color all round, color that here would seem garish but there will seem blanched in the vibrancy of ambient blue-sky light. I want to see light bending off water and water that looks blueblueblue, not this dark green black stuff that we call "the ocean" here where I live, that up close reminds me of wrinkled, liquid trash bags rippling slightly in the breeze, weakly fwapping at the shoreline, sucking away sand, depositing dead cold darkgreenbrown slimey seaweed. I want sharp contrast, not fuzzy edges. I want black shadow, not a dull grey haze. I want light that hurts my eyes, burrows directly into my brain, forces me to wear shades to protect my peepers from sheer sizzle. I want to be dazzled by direct light, not fooled by artificial street lights tossed haphazardly upward from puddles on the street, not placeboed by a sun lamp with which, frankly speaking, the honeymoon was over long ago. Let there be light. Real light. Honest. Sun. Light. Puhleeze.

Update Nov.30
My friend "anonymous" has written to me again. This time, he said he agreed that avoiding neck manipulation was a good idea (which is a step forward), but said I was off the mark on chiro education. Come on Anon, get over yourself. Perhaps your chiro school was (relatively) wonderful, but I have it on quite good authority that there is no particular standard amongst U.S. chiro schools. So don't presume to speak on behalf of all chiro. Go read Chirotalk, where I get all my info about chiro from ex-chiros who are fighting their way back to sanity, who engage true believers in hilarious discussions. It was you who drank the chiro koolaid, not me - I see no reason to change my overall opinion of chiropractic.

This is just plain funny

Check out the thread on Chirotalk called The Chiro Zone.

Brain Science Podcast #42: "On Being Certain"

In reference to Alberta woman with chiropractic stroke sues bigtime:

Ginger Campbell's latest podcast is about the book, "On Being Certain: Believing You Are Right Even When You're Not ", by neurologist Robert A. Burton, MD.

About half way through it, she says;

"Earlier on I asked the question, "What would be the possible benefits of "a feeling of knowing" that is actually false?" This brings us to a consideration of our brain's reward systems, and how they interact and influence our thoughts.

We know that there are extensive connections between the pleasure rewards systems, emotions, and the opioid peptides in the brain. We have talked about in the past the mesolimbic-dopamine system, which is a key component of the brain reward circuitry that originates in the upper brainstem. It, not surprisingly, seems to use dopamine as its key neurotransmitter. This mesolimbic dopamine system connects to the parts of the brain that are involved in emotion and cognition, including parts of the frontal lobes, and the nucleus accumbens which is thought to be involved in addiction. It's been shown that brain mediated rewards cause behaviours to persist, including addictions.

So you have to wonder, how is this related to the feeling of knowing? Dr. Burton gives an example in the book, of a person faced with a charging lion, who climbs up in a tree and survives. After the person escapes he has the feeling that he has learned something. And if you make these sorts of decisions repeatedly, you will probably have a positive feeling of "correctness" that becomes linked to that behaviour.

Dr. Burton argues that the feeling of knowing and feelings of familiarity are integral to learning."

Fine, so why am I bringing this forward? Because my human primate social grooming brain thinks humans are learning machines who:
1. can learn all sorts of crazy things
2. learn all sorts of physical actions
3. make up all sorts of bizarre and sometimes dangerous rituals

.... that often fall into the category of "stupid human tricks."

Among these, I would definitely put neck manipulation of the high velocity sort.

I can't prove it, but have always suspected that both doing it and having it done to one's own person likely belong in the category of "addictive behaviours" as well as "stupid human tricks", but this is the first time I've heard a (potentially associated) brain pathway actually spelled out.

No one in the greater HPSG sub-troop acts more "certain" of themselves, on the whole, than those practitioners who favor this approach. Except possibly the patients who've been on the receiving end of it, convinced that it "helps" them, even when they still "need" it monthly for 10 years, etc. (See Keith's observations/comments in "Alberta woman" link.) I'd put that in the category of "false knowledge"; the feeling of being certain outweighs the obviousness that it doesn't really help much of anything at all, except a reward pathway (temporarily) and furthermore only reinforces a behaviour peculiar to humans, reinforces a pathway that goes nowhere and does nothing permanent, does not give the brain a chance to learn a new behaviour toward self-sufficiency.


Further reading:

1. Harriet Hall's review of the same book.
2. Is certainty a dopameme?


August 8/08

I'm back into this post to drop a link to Ginger Campbell's Podcast #43, an interview with the author. It really rips along - give it a listen! Thumbs-up.

Alberta woman with chiropractic stroke sues bigtime

A class action lawsuit has been filed against chiropractic in Alberta. A woman was turned into a quadriplegic by a chiropractor.

More of these cases are coming to light all the time. Rather than writhing in shame the way a profession should if lives are ruined at constant spaced intervals by its own "rock star" type of human primate social grooming, chiropractic shrugs and moves on, lets the individual chiropractor take the hit and acts like it's not the profession's fault.

This is an unconscionable attitude to take. I've always thought so and I always will.

In this case, (as I understand it) the woman and her husband are hoping to take the profession itself, and the provincial government which subsidizes it to court instead.

Nobody "needs" this kind of high-neck manipulative intervention on a regular basis to maintain their "health." Never let ANYONE tell you otherwise, no matter how charming they seem. It's a lie. It's a crock. Don't let anyone twist your neck for any reason. It's dangerous.

Watch the video, Kinsinger Report on Chiropractic.

Here is more information:
1. Chirotalk thread on the topic (Chirotalk is a board run by sane ex-chiropractors which means it's anti-chiropractic)
2. Old blog post, How I really feel about chiro
3. Please sign this petition against neck manipulation. Seriously, folks, this is a malevolent and thoroughly unnecessary human behavior that should be extinguished completely. Analysis of all the hidden symbolic dominance-submission ritual content it contains can wait until after it's been de-legalized.
4. Paralyzed woman sues chiropractic for half billion
5. Alberta woman launches massive chiropractic lawsuit
6. Sandy Nette's website
7. Action for Victims of Chiropractic (UK)
8. Video (short) Is a Headache Worth Dying For?
9. Chiropractic Lawsuit, blogpost by Steven Novella at Neurologica Blog
10. Adverse effects of spinal manipulation: a systematic review (JRSM 2007)
11. A Deadly Twist (story of another survivor of chiropractic stroke)
12. Chiropractic and Stroke (blogpost by Harriet Hall, MD and skeptic)
13. Another survivor, Graham Maynard's site
14. Stroke after chiropractic (CNN)(short video of a news clip)
15. Fact sheet on the class action (7-page pdf)
16. Doctor Who? Deception by chiropractors, by David Colquhoun
17. Chiropractors resort to legal intimidation, by David Colquhoun

Here are videos from the Nette couple's website, sandynette.com:

1. Sandy Nette's Story (about 8 minutes. Sandy speaks through a message board)
2. David Nette's Story: Part 1 (about 10 minutes. David talks about what happened at the hospital initially.)
3. David Nette's story: Part II (about 10 minutes. David talks about how he adjusted to the new situation he found himself in with his wife.)
4. David Nette's story: Part III (about 9 minutes. David talks of their shared resolve to prevent this ever happening to any other person, by launching the class action lawsuit.)

These videos are very revealing, very, very real and raw. They are a must-see.
........................................


June 20/08:

Since I put this blogpost up I've received a couple comments from one or two readers, both named "anonymous." I did not allow their comments to appear. They are glaringly pro-neck-manipulation, and I think the pro-neck-manipulators have already had far too much leeway in the realm of swaying public opinion to give them any sort of platform, however buried, obscure and humble this blog may be.

It's because of:
1. chiro training in a rationalized (as opposed to rational), deliberately propagated, bizarre belief system, combined with
2. a cultivated and honed persuasive attitude,
3. which appears aimed at propagating reckless enactment of a type of human physical social grooming (high-neck-manipulation) which is irrelevant and unnecessary in the first place,
4. against all common sense AND scientific investigation,
5. for the sole purpose of making $,

... that this woman became tetraplegic.

I have too much respect for the human nervous system to ever condone manipulation of its high-neck housing; therefore, "anonymous," I consider my prevention of your promotion of it on my blog, a positive choice - an action (however tiny) against letting myself and this blog be a vector for further perpetuation of your particular memeplex. And I happen to think it's an accumulation of tiny actions that count in life.

July 6/08:
Back in with this blog thread from Science-Based Medicine on this case.

July 17/'08
Back in with another Science-Based Medicine blog thread which deconstructs a chiro article which suggests patient visits to chiros and patient visits to medicos result in the same numbers of strokes overall.

Sept.28/08
Calgary Herald article by John William Kinsinger MD, Jun 21/08: Cracking necks destroys lives

Nov.16/08
Last night CTV's news program, W-FIVE, examined Sandy Nette's lawsuit. The program provides a glimpse into her life - it looks like she is able to use her left hand a little bit now. The viewer is introduced to a few of the others (people who had strokes shortly after chiro manipulation, some of whom recovered and others who didn't) who also are part of the class action suit.
The clip from W-FIVE

Jan.6/09
SPARC : Stroke Prevention & Atherosclerosis Research Center
Strokes From Neck Injury

Blogpost on bilateral internal carotid artery dissection from chiropractic neck manipulation.

Jan.7/09
Paciaroni M, Bogousslavsky J; Cerebrovascular Complications of Neck Manipulation.
European Neurology 2009;61:112-118 DOI: 10.1159/000180314
(If that link doesn't work, go here and click on full text or pdf.)

Feb 10/09
Harriet Hall, Chiropractic’s Pathetic Response to Stroke Concerns

August 4/09
Beware the Spinal Trap Simon Singh
“We are more possible than you can powerfully imagine” Ben Goldacre, Bad Science blog

Is certainty a dopameme?

OK, first a disclaimer: dopameme is a word I made up, just because I thought it was necessary. I'm not entirely sure yet of everything it might mean..
Here is the definition.

Dopameme: Noun; Combination of the name of a neurotransmitter in the brain involved in feeling pleasure, "dopamine", and the term "meme" as coined by Richard Dawkins meaning a thought virus.

A "Dopameme" is a feel-good idea which:

1. forms part of a belief system (e.g., "new age" notions or pseudo/antiscience)
2. keeps people from learning to see the world rationally
3. stubbornly persists through generations, because the emotional comfort or pleasure it provides the person who harbours it ensures it will be replicated frequently in that individual's brain and easily passed on to others via social and conversational contact
4. gets recycled endlessly through books sold at spiritual and self-help bookstores, thus helping support the economy, thus further ensuring its continued survival

Dopamemes can be found in any walk of life but find particularly fertile ground in the helping professions, if fact are actively cultivated by many of them which appear to base their whole existence around farming them for profit.

This morning Harriet Hall at Science-Based Medicine reviewed a new book in her blog entry On Being Certain; the book is On Being Certain: Believing You Are Right Even When You're Not, by Robert Burton. In her review Hall says,

"A “feeling of knowing” probably had an evolutionary advantage. If we are certain, we can act on that certainty rather than hesitating like Hamlet. Certainty makes us feel good: it rewards learning, and it keeps us from wasting time thinking too much; but it impairs flexibility."

This is intriguing, and makes me want to expand the definition of "Dopameme" (the extent of which I am still uncertain) to include a new point:

5. like "certainty", provides emotional comfort by removing the cognitive dissonance of "not knowing."

Coincidentally there has been a very busy thread called Chiropractic and Stroke, also by Harriet Hall, with many comments (arguments from "certainty"), running concurrently.

How I really feel about chiro

In reference to What the ....?:

What is irritating about the chiro blogathon site mentioned previously (to which my own (PT!!!!) blog has been attached without my permission), is that there is no contact address provided so that I can protest directly about my blog being lumped in with chiro blogs.

There is, however, a little paypal thingy so that people may "donate" to help "maintain" the site... how chiropractic. Really.

I haven't been very outspoken on this blog about how I really feel about chiropractic. When I say anything much about manipulative therapy, I usually lump orthopaedic manual therapy in with chiro as being nearly indistinguishable on the surface, i.e., in that both groups love to manipulate, want to keep SMT (spinal manipulative therapy) alive as a treatment. I think this is still true; however, I may have been a bit myopic because of how I've been a PT for nearly 40 years and have never needed to use SMT on anyone. Upon digging deeper, and as a clarification, and to reassure ortho PTs that when I have to pick, I will always pick them over chiro any day, I offer this blog post.



Evidence in Motion

At Evidence in Motion, there is a nice thread about chiro in general and about cervical (neck) manipulation (which I have always, always been opposed to) in particular. The thread points out the video, Kinsinger Report on Chiropractic (about a half hour). It's worth talking about this very informative video for awhile, which I will do in a minute. But first, I want to say that I think this thread represents a good example of what "evidence" can be used for - i.e., it can be used to highlight chiro hubris, blow holes through chiro hegemony. A chiro came on the thread to attempt to dissuade readers away from the Kinsinger video, and a PT came on to say, au contraire, here is evidence to support the contentions made in the video about cervical manipulation risk. If you would like to examine this more closely, read the thread itself.


The Kinsinger video

So, I want to discuss the actual video now: In it, Bill Kinsinger, an MD, points out the public perception of chiropractic: i.e., an

"advanced form of physical therapy with a focus on treatment of low back pain."

He points out the perception chiropractic has of itself: i.e., an

"alternative comprehensive health care profession whose practitioners see patients on a primary care level treating everything from ear infections to PMS."

Then he points out the medical and physiotherapy view of chiro: i.e.,

"a philosophical belief system based on ideas that are not only unscientific, they are actually anti-scientific."

I agree. In fact, I couldn't agree more.
He says chiropractic has remained virtually unchanged since 1895. The ideas it is based on have not evolved, that the field more closely resembles a religion or a cult than a health care profession.

Kinsinger covers the main details on how chiropractic originated (a Canadian immigrant to the U.S., D.D. Palmer, founded it. As a Canadian, I apologize deeply for this..). By way of example for how non-evolved chiropractic is, he points out its superglue-like adherence to a concept called "vertebral subluxation complex" that has never been shown to exist, was something dreamed up by Palmer, and still rules chiro thinking. He goes on to outline what he terms "milestones to legitimacy", or how chiro has managed to crowbar its way into legitimacy through political ways and means. He discusses the fight (won by reason) in Florida a few years ago to keep a chiropractic program out of Florida State University. He talks about how PT has done most of the existing research on manipulative therapy. He points out:

1. the questionable benefits for musculoskeletal concerns and flat-out non-benefit for non-musculoskeletal concerns

2. the anti-vaccination statements emblazoned over doorways in chiro schools

3. risk of stroke associated statistically with over utilization of neck manipulation

He invites people to check out the grass-roots advocacy groups such as Neck 911. He ends his presentation by saying that PT provides the best hope for the future of manipulative therapy.

Other than my own personal dislike for manipulative therapy (i.e., the high-velocity kind) I agree entirely with this entire video.


Further links and resources

1. Neck 911

2. Petition: Legislate to Warn Public that Neck Manipulation can cause a Stroke (an Australian initiative)

3. The Kinsinger video, The Kinsinger Report on Chiropractic

4. The Evidence in Motion thread, Extra! Extra! The Kinsinger Report on Chiropractic

5. Chirowatch.com (read about the foiled plans to insert a chiropractic school at FSU, Jan/2005.)

6. Science-Based Medicine blogs in their chiro category

7. Chirotalk: The Skeptical Chiropractic Discussion Forum

8. Confessions of a Quackbuster (many many many more counter-chiro links at this blog)

9. Screwed4life ex-chiro blog

10. Chiropractic is Quackery squidoo page

11. Duplicitous Primates ex-chiro blog

12. (Added June 13/08) Alberta woman sues chiropractic after being made quadriplegic by a chiropractor, also this.


NOW, PLEASE TAKE THIS BLOG OFF YOUR CHIRO BLOG LIST. THANK YOU.